It was August 2017, and pleasant and breezy in the central mountains of Madagascar. The passengers loading their bags into the minibus leaving Ankazobe, a small town in the highlands, were grateful for the morning coolness. It would be warm and sticky on the trip they were taking to Antananarivo, the island’s million-person capital 100 kilometers to the south, and then to Toamasina on the coast, another 350 kilometers away. One of the passengers, a 31-year-old man, looked uncomfortable already. Four days before, he had arrived on a visit. Now he was headed home, but he was feverish, achy, and shaking with chills.
